Health Care Finance, Economics, and Policy for Nurses: A Foundational Guide, 2nd Edition PDF by Betty Rambur

By

Health Care Finance, Economics, and Policy for Nurses: A Foundational Guide, Second Edition

By Betty Rambur

Health Care Finance, Economics, and Policy for Nurses: A Foundational Guide, Second Edition

Contents

Foreword to the Second Edition, Peter I. Buerhaus, PhD, RN, FAAN, FAANP(h) ix

Foreword to the First Edition, Susan B. Hassmiller, PhD, RN, FAAN, and Susan Reinhard, PhD, RN, FAAN xiii

A Note From the Author xv

How To Use This Text: A Note to Faculty xvii

Acknowledgments xxiii

SECTION I. THE CONTEXT OF HEALTH CARE AND HEALTH CARE REFORM 1

  1. What Is Health Economics and Why Is It Important to Nurses? 3

Theoretical Economic Approaches 5

Social Determinants of Health 6

How Economics Differs From Financing and Reimbursement 8

  1. A Story of Unintended Consequences: How Economic and Policy Solutions Create New Challenges 25

The Influence of the Flexner Report 27

Early Hospitals 29

Social Reform Addressing Unintended Consequences of Employer-Based Insurance 30

Attempts to Change Financial Incentives to Contain Costs 33

The Affordable Care Act and New (and Renewed) Payment Models 37

COVID-19 38

  1. The Patient Protection and Affordable Care Act of 2010 45

The Patient Protection and Affordable Care Act of 2010 45

Insurance Access—Employer Mandates and Medicaid Expansion 47

Insurance Access—Expanded Eligibility 48

What About Those Who Are Still Not Covered By One of These

Mechanisms? 49

What Does the Health Care Exchange Do? 50

Where Can a Nurse Direct a Patient Who Asks Questions About How to

Navigate the Complex Terrain of Health Insurance? 66

Insurance Lessons From COVID-19 66

  1. Payment Reform 73

From Volume to Value: Payment Models That Move

Away From Fee-For-Service Reimbursement 74

Nursing Roles Within Emerging Payment Models 90

SECTION II. HEALTH CARE ECONOMICS: AN OVERVIEW 97

  1. How Health Care Markets Differ From Classic Markets 99

What Does It Mean to Bear the Consequences of Financial

Decision-Making? 99

What Ideas Help Us Understand Overtreatment?

The Example of Small-Area Variation and

Supplier-Induced Demand 108

  1. The Role of Information in Health Care Markets

and Decision-Making 117

The Need for Information 117

Data on Quality 125

Data Science 127

Information Science, Quality Science, and Data 134

  1. Market Entry, Exit, and Antitrust Law 143

Entering and Exiting the Market 144

Merge, Consolidate, or Stand Alone: An Overview

of Antitrust Law 149

Is Consolidation the Same as Integration? 149

SECTION III. ETHICS AND ECONOMICS IN AN AGE OF REFORM 155

  1. What Is Ethinomics? 157

Can Economics Coexist With the Intention of “Doing Good”? 157

Social Determinants of Health, Health Disparities, Ethics, and

Economics 160

Moral Conduct of Nurses in Contemporary Complexity 165

  1. Additional Models to Guide Ethical Decision-Making 173

Consequence-Based Decision-Making 174

Deontology: Rule-Based Decision-Making 175

Virtue Ethics 176

Using These Models in Clinical Decision-Making 177

Moral Distress 179

Ethics and Clinical Decision-Making During Pandemics 180

Ethics of Reform and Cost Containment 182

Sustainability Is an Ethical Issue 184

Nurses on Boards and in Politics 185

SECTION IV. PULLING IT ALL TOGETHER: USING YOUR

KNOWLEDGE OF HEALTH FINANCE, ECONOMICS, AND

ETHICS TO INFLUENCE HEALTH AND

HEALTH CARE 191

  1. Governance and Organizational Type 193

Role of the Board of Trustees 194

Types of Hospitals and Health Systems 196

Navigating Governance–Management Boundaries 200

The Relationship Between Organizational Structure and

Organizational Values 204

The Role of Board Committees 205

The Sarbanes–Oxley Act 206

  1. Building Skills for Board Membership 213

Zeal, Organizational Fit, and Philanthropy 213

Types of Board Appointments 214

What a Governing Board Is Not 215

Other Types of Boards 216

Building the Skill Set for Board Membership 217

Next Steps 227

  1. Applying Health Economics to Influence Health Care

Through Federal and State Policy Formation 231

Branches of Government 232

Influencing at the Committee Level 235

Timing Matters 235

Maintaining A Connection with Policy Makers to Influence

Health and Health Care 237

Ways of Influence 242

Lobbying as Official Authority to Represent A Group View 243

Grassroots Lobbying 244

How to Contact Policy Makers 244

Overcoming Impediments to Involvement 246

Learning from Distant Others 247

Learning from At-Hand Mentors 248

  1. Early Lessons From the COVID Pandemic and a

Look to the Future 255

  1. Epilogue: Reflections on Living and Leading in a

Changing Nursing World 265

Tell Me One More Time: What Does All This Financing,

Economics, and Policy Have to Do With Nursing? 265

How to Retain and Expand on What You Have Learned 266

  1. Quiz Answers 269

Appendix A Medicare Eligibility 275

Appendix B Key Concepts in Health Finance, Economics,

Policy, and Ethics: Level Setting Pre-Survey 277

Appendix C The Policy Analysis Process 281

Glossary 285

Index 291

This book is US$10. Order for this book:
(Request for free sample pages click on "Order Now" button)

Book Order
Or, Send email: [email protected]

Share this Book!

Leave a Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.